Torticollis

Torticollis is also known as Wryneck. It is a condition of twisting of the neck that causes the head to tilt and rotate. Wryneck, or torticollis, is a painful condition in which the top of the head tilts to one side while the chin tilts to the other side. This condition may be present at birth or may be acquired. It can also occur due to damage to the neck muscles or blood supply.

Types of Torticollis

·    Temporary Torticollis

This type of torticollis mostly disappears after one or two days. It can be due to ear infection, cold or swollen lymph nodes, or injury to the head and neck.

·   Fixed Torticollis

Fixed torticollis or permanent torticollis occurs due to a problem in bone or when the neck muscles of one side are scarred or tight.

·    Klippel-Feil Syndrome

It is a congenital form of torticollis, the bones in the baby's neck are not formed properly, and the two neck vertebrae are fused. Children born with this condition may have difficulty in vision and hearing.

·    Cervical dystonia

This is a rare disorder sometimes referred to as spasmodic torticollis. It is caused due to the contracture or spasm of the neck muscles. The head is twisted or turned painfully to one side. It may also tilt forward or backward. Cervical dystonia sometimes goes away without treatment, but there can be a risk of recurrence.

The exact cause of torticollis is unknown.

Congenital muscular torticollis is more likely to happen in first-born children. It occurs due to the position of the uterus resulting in the injury of the neck muscles.

Acquired torticollis may be caused due to the irritation to the cervical ligaments because of viral infection or vigorous movement and

Other causes can be like:

•  Sleeping in an awkward position.
• Neck muscle spasm
•  Burn injury.
• An injury that causes scarring and shrinkage of skin or muscle.
• Burn injury.
• Torticollis may also be associated with a herniated disk, slipped facets, and viral or bacterial infection.
• Due to damage to the muscles or blood supply.
• Due to damaged neck muscles or blood supply. 

Sometimes, each person may experience symptoms differently. Symptoms can begin slowly and may also worsen over time. The most common symptoms include:

·         Neck muscle pain

·         Inability to turn the head, holding in a twisted position.

·         Spasm of the neck muscles

·         Awkward position of the chin

·         Inability to turn the head in a normal position.

·         Stiff neck

·         One-shoulder higher than the other

·         Chin tilt to one side

·         Babies with Congenital torticollis may have flattened and unbalanced faces.

·         Motor skill delays or difficulties in vision and hearing.

Pathology

It occurs due to unilateral shortening and contraction of the sternocleidomastoid muscle. There is a deposition of collagen and migration of fibroblasts around the muscle fibers, leading to limitation of head mobility causing neck contracture.

Diagnosis of torticollis can be confirmed with a medical history and physical examination.

Electromyogram:

An electromyogram (EMG) measures the electrical activity in the muscles and also determines which muscles are affected.

X-rays:

X-ray Imaging tests such as X-rays can be used to check any bony problem.

MRI:

MRI scans can also be used to find structural problems that might the symptoms.

Treatment of torticollis

Torticollis sometimes goes away without treatment. Chronic wry neck can cause pain and difficulty neck movements. Medications and physiotherapy can relieve pain and stiffness. Surgery can also be used as a treatment in severe cases. Children with torticollis need surgery to lengthen the sternocleidomastoid muscle. Treatment is most successful if it's started in early-stage especially during childhood.

Medication

Muscle relaxants, botulinum toxin injections, pain medications.

Note: Medication should be taken under the doctor's prescription.

There's no way to prevent torticollis. However, getting treatment quickly can prevent it from becoming worse. Congenital forms of torticollis can be treated by stretching the neck muscles, only if immediate treatment is started within a few months after birth. If this or other treatments does not work, surgery is the next step.

Neck collar:

A neck brace or soft collar helps to keep the neck from moving.

Thermotherapy:

Heat Therapy or thermotherapy helps the sore neck muscles to lessen the pain.

Ultrasound therapy:

Ultrasound therapy produces high-frequency sound waves which travel deep into tissue and create gentle therapeutic heat, which helps in the recovery process.

Massage:

Massage therapy or Neck massage may also help lessen your neck pain.

Chiropractic care:

Chiropractic adjustments can be utilized to help relieve symptoms of torticollis and can even aid in healing the condition.

Stretching exercises:

Passive range of motion and gentle stretching exercises can help the baby achieve full neck motion.

Exercises rotation, Side bending, and Sitting stretching:

The parent should sit with the back against the wall and the knees bent. Hold the child and stretch his tight muscle. All the exercises should be done at regular intervals.